Early induction of abortion by a combination of oral mifepristone and misoprostol administered by the vaginal route

Abstract

Medically induced abortion using a new regimen of oral mifepristone 600 mg and vaginal misoprostol 800 micrograms (PGE1 analogue) was carried out in 100 women. Abortion occurred in all patients without resort to surgery. In 99 women, the abortion occurred within 4 hours of the administration of the prostaglandin. Sixty-seven patients did not request any form of analgesia. This regimen is highly effective, has a low incidence of side effects (mainly gastrointestinal) and appears to be highly acceptable to women.

PIP: Obstetrician-gynecologists recruited 100 women (mean age = 24.1 years and mean duration of amenorrhea = 51 days) attending the Aberdeen Royal Infirmary in Scotland to undergo elected abortion into an open study of the use of a new regimen of oral mifepristone (600 mg) and vaginally-administered misoprostol (800 mcg). This was the first pregnancy for 77 of the women. No surgical intervention was required in any of the cases. The conceptus was expelled and confirmed within 4 hours after administration of misoprostol in 99 women. The other woman aborted within 2 hours after an ultrasound scan. One women bled heavily and did not completely abort. She was readmitted to the hospital, where she received a blood transfusion. An oxytocic injection resulted in a complete abortion. One woman had a complete abortion with just mifepristone. Vomiting (17%) and diarrhea (12%) were the leading side effects. None of the women with these gastrointestinal effects needed any treatment. Most women (66%) did not ask for any analgesia. Bleeding after the abortion lasted on average 9.5 days. Before and after mean hemoglobin levels were similar (13.1 and 12.9, respectively). No one developed an infection. These findings support those of another study that misoprostol administered vaginally is much more effective at terminating pregnancy than when it is administered orally. They also show that women find vaginally administered misoprostol very acceptable.